Cardiac resynchronization therapy parameter optimization

Abstract

Systems and methods involve determination of CRT parameters using a number of CRT optimization processes. Each CRT optimization process attempts to return recommended parameters. The CRT parameters are determined based on the recommended parameters returned by one or more of the CRT optimization processes. The CRT optimization processes may be sequentially implemented and the CRT parameters may be determined based on the recommended parameters returned by a first CRT optimization process to return recommended parameters. The CRT parameters may be determined based on a combination of the recommended parameters returned. The CRT optimization processes implemented may be selected from available CRT optimization processes based on patient conditions.

1 . A medical device, comprising:
 cardiac resynchronization therapy (CRT) optimization circuitry configured to:   implement a first cardiac resynchronization therapy (CRT) optimization process which returns a first recommended value for a CRT parameter,   implement a second CRT optimization process which returns an second recommended value for the CRT parameter,   determine whether the first recommended value and the second recommended value are within a range,   if the first recommended and the second recommended value are within the range, use one or more of the first recommended value and the second recommended value to determine a value for implementing CRT, and   if the first recommended and the second recommended value are not within the range, implement a third CRT optimization process.   
     
     
         2 . The medical device of  claim 1 , wherein the CRT optimization circuitry is configured to implement the first CRT optimization process using a first set of physiological signals and to implement the second CRT optimization process using a second set of physiological signals. 
     
     
         3 . The method of  claim 1 , wherein the CRT optimization circuitry is configured to combine the first and second recommended parameter values based on one or more of a weighted average, voting, fuzzy logic, and physician input. 
     
     
         4 . A medical device, comprising:
 cardiac resynchronization therapy (CRT) optimization circuitry configured to:   select CRT optimization processes for a plurality of targeted physiological functions,   implement the plurality of CRT optimization processes, each CRT optimization process returning a recommended parameter value for a targeted function of the plurality of targeted physiological functions, and   combine the recommended parameter values to determine a value for implementing CRT.   
     
     
         5 . The medical device of  claim 4 , wherein one of the plurality of targeted physiological functions comprises a systolic function. 
     
     
         6 . The medical device of  claim 4 , wherein one of the plurality of targeted physiological functions comprises a diastolic function. 
     
     
         7 . The medical device of  claim 4 , wherein one of the plurality of targeted physiological functions comprises reverse remodeling. 
     
     
         8 . The medical device of  claim 4 , wherein the CRT optimization circuitry is configured to determine combined optimization criteria for the plurality of targeted physiological functions. 
     
     
         9 . The medical device of  claim 4 , wherein the CRT optimization circuitry is configured to select a sensor for each of the targeted physiological functions. 
     
     
         10 . The medical device of  claim 9 , wherein a first targeted function comprises a systolic function and the selected sensor for the systolic function comprises an electrocardiogram (EGM) sensor. 
     
     
         11 . The medical device of  claim 10 , wherein a second targeted function comprises a diastolic function and the selected sensor for the diastolic function comprises a heart sound sensor. 
     
     
         12 . A medical device, comprising:
 cardiac resynchronization therapy (CRT) optimization circuitry configured to:   select one or more CRT optimization processes based on one or more patient conditions;   implement the one or more CRT optimization processes, each CRT optimization process returning a recommended parameter value for implementing CRT; and   combine the recommended parameter values to determine a parameter value for implementing CRT.   
     
     
         13 . The device of  claim 12 , wherein the CRT optimization circuitry cardiac is configured to determine the patient conditions. 
     
     
         14 . The device of  claim 12 , wherein the patient conditions comprise patient activity level. 
     
     
         15 . The device of  claim 12 , wherein the patient conditions comprise AV block. 
     
     
         16 . The device of  claim 12 , wherein the patient conditions comprise atrial fibrillation. 
     
     
         17 . The device of  claim 12 , wherein the patient conditions comprise interatrial block. 
     
     
         18 . The device of  claim 12 , further comprising a user interface configured to receive patient condition information. 
     
     
         19 . The device of  claim 18 , wherein the patient condition information comprises one or more of historical information, patient medical history, physiological information, non-physiological information, contextual information, and questionnaire information. 
     
     
         20 . The device of  claim 12 , wherein the one or more CRT optimization processes comprise one or more of a CRT optimization process based on measurement of activation timing, a CRT optimization process based on EGM signal morphology, a CRT optimization process based on left atrial (LA) EGM timing, a CRT optimization process based on pre-excitation, a CRT optimization process based on mechanical sensor signals, and a CRT process sensitive to posture changes.